Aim: Sarcopenia is associated with poor prognosis in adult
oncologic patients, with little evidence of this association in
pediatric population, including hepatoblastoma. Methods:
Retrospective study in patients with hepatoblastoma, divided into those
with or without sarcopenia. Sarcopenia was assessed by measuring psoas
muscle area (PMA) at L4-L5 level on the CT/MR and defined as z-score
values ≤2. Relapse and mortality were analyzed. Results:
Twenty-one patients (57.1% male) were included, with median age 35.7
months (IQR: 23.5-58.5). Seven (33.3%) had sarcopenia on initial
studies compared to 14 (66.7%) who did not. No differences were found
between groups in age, weight, PRETEX, surgical treatment or
a-fetoprotein levels. Twelve (57.1%) underwent liver resection and 9
(42.9%) liver transplantation. Sarcopenia was associated with a higher
rate of metastases at diagnosis (49.2% vs 0.0%; p=0.026) and surgical
complications (57.1% vs 21.4%, p=0.047). After a median follow-up of
65.1 months (1.7-144.8), 2 patients (28.6%) had tumor relapse in
sarcopenic group compared to 1 (7.1%) in non-sarcopenic group. Two
patients died in sarcopenic group and 1 in non-sarcopenic group. Median
event-free survival (EFS) was lower in sarcopenic group
(100.38±25.63vs118.91±11.52 months) as well as overall survival (OS)
(101.72±24.86 vs 121.78±8.75 months) with no statistical significance.
Five-year EFS was also lower in sarcopenic group (71%vs93%) as well as
5-year OS (71%vs87%). Conclusions: Sarcopenia at diagnosis
was associated with a higher rate of metastases and surgical
complications in hepatoblastoma. Our data shows the first evidence of
its role as a possible poor prognostic factor, influencing survival and
risk of relapse.
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